2017 Citizen of the Year Nomination Form

The Santa Rosa Metro Chamber is planning for the 2017 Annual Gala in which we will be honoring community leaders.

The winner will be honored at the Annual Gala on October 19, 2017.

You are invited to submit nominations — self-nominations are encouraged. Please see below for nomination instructions and criteria:

Please be as complete as possible when listing the reasons for the nomination. You may wish to talk to other people who may have additional information on the nominee.
One nominee per submission. Feel free to nominate other potential honorees by submitting a separate online form.
The deadline for nominations is Friday, August 11th, at 5:00 pm.
Winners will be contacted in late-August.

Criteria for Nomination of Citizen of the Year

Award will be presented to the individual or family who has demonstrated active participation in civic or community activities.

Name of the Nominee

Contact (if different than nominee)

Nominee's Phone Number

Nominee Cell Number

Nominee's E-mail Address

How has this individual volunteered in the community?

How has this individual distinguished themselves from other individuals in the community?

How has this individual shown leadership abilities to motivate others to benefit the community?

How has the individual made a significant positive impact in the community?

List any additional factors in support of the individual.

Nominated By

Your Business or Organization

Phone

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